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The  Value  of  the  Library  in  the  Hospital 
for  Mental  Disease 

By  Edith  Kathleen  Jones. 

Librarian  at  McLean  Hospital,  Waverley,  Mass. 

THE  Superintendent  of  one  of  our  large  private  hospitals  for 
the  insane  recently  made  the  remark  that  if  he  were  obliged 
to  give  up  either  the  library  or  the  handicrafts  department,  he 
would  unhesitatingly  choose  to  keep  the  former.  His  reason  was 
this:  That  there  are  always  many  patients  who  cannot  be  roused 
to  any  great  interest  in  arts  and  crafts  work,  while  there  are 
very  few  who  will  not  read,  or  at  least  look  at  books  of  pictures 
The  criticism  may  be  and  often  is  made,  that  while  this  may  be 
true  of  the  private  hospital,  where  the  patients  come  from  the 
so-called  “cultured  class,”  the  state  hospital  is  largely  made  up 
from  the  “uncultured”  classes, —workers  in  mills  and  factories, 
aliens,  and  persons  who  presumably  do  not  care  for  books  and  on 
whom  a library  would  be  wasted.  To  a certain  extent  this  is  so; 
but  an  examination  of  the  case  records  of  state  hospitals  show 
that  they  all  have  a large  percentage  of  school  teachers,  librari- 
ans, college  professors,  ministers,  and  other  persons  of  the  same 
mental  grade,  whose  finances  do  not  allow  them  to  be  cared  for  in 
private  institutions,  but  who  are  as  used  to  refined  and  cultured 
surroundings  as  their  more  affluent  ’neighbors  in  the  more  expen- 
sive hospitals.  And  these  are  the  patients  who  suffer  from  the 
lack  of  the  finer  elements  of  life,  and  to  whom  books  and  pictures 
are  the  key  to  temporary  oblivion  of  their  condition  and  sur- 
roundings. Granted  that  the  percentage  of  such  patients  is  small 
compared  with  the  number  of  mill  and  factory  hands,  even  for 
these  few,  an  up-to-date,  well-selected  library  is  necessary  to 
their  happiness  and  well-being,  and  happiness  is  a great  factor 
toward  recovery  and  health. 

Moreover,  for  the  many— the  uneducated— much  may  be  done 
to  interest  them  in  good  books  and  raise  their  mental  standard. 
To  be  sure,  one  who  has  read  only  such  trash  as  the  lurid,  mor- 
bidly sentimental  dime  novel  type,  cannot  at  once  appreciate 
Thackeray,  for  instance;  but  he  will  read  with  pleasure  certain 
“half-way”  books,  and  thus  insensibly  may  be  lead  up  to  a 


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knowledge  and  appreciation  of  the  best  in  the  great  world  of 
literature.  That  this  education  can  be  and  has  been  accomplished, 
'is  evidenced  in  a letter  received  in  the  Fall  of  1913  from  a librari- 
an interested  in  the  hospitals  and  prisons  of  an  adjacent  state. 
“One  of  our  neighbors,’ ’ she  writes,  “has  for  the  last  eleven 
years  read  four  hours  a week  to  the  women  patients.  She  could 
see  an  improvement  from  year  to  year.  She  was  reading  the 
very  best  in  literature  to  an  audience  which  appreciated  it,  but 
the  funds  are  not  available  and  the  work  is  stopped.  If  some  of 
these  politicians  could  only  see  the  results  secured  by  interest  and 
personal  enthusiasm,  they  might  not  take  such  a cold-blooded 
view  of  the  questions  regarding  the  wards  of  the  state.  It  is  so 
inhumane  to  dole  out  money  as  if  they  were  cattle, —so  much 
food,  so  many  officers,  so  much  medicine  etc.  These  are  founda- 
tional—people  really  live  on  top  of  this  comfort  line,  where  ed- 
ucation, employment,  play,  intellectual  and  spiritual  life  keep 
people  happy,  as  well  as  merely  comfortable.”  y“T‘ 

This  letter  was  written  before  Dr.  Richard  Cabot  published  the 
papers  in  the  Atlantic  Monthly  recently  expanded  in  book  form 
and  called  “What  Men  Live  By— Work,  Play,  Love,  Worship;” 
but  the  thought  is  the  same.  If  these  are  the  essentials  for  the 
physical  and  mental  health  of  normal  persons,  how  much  more 
should  the  principle  be  applied  toward  re-educating  those  who 
have  fallen  into  wrong  habits  of  thought  and  life!  And  what  bet- 
ter means  have  we  of  inculcating  these  principles  than  a well- 
selected  library  of  the  best  books  in  fiction,  literature,  travel, 
biography,  history,  art  and  science?  Here  we  have  not  only 
relaxation  and  pleasure  for  the  mind,  but  healthful  stimulus  to 
thought  and  feeling,  food  for  the  mental  and  spiritual  life. 

Work  has  always  been  provided  in  the  state  hospitals,  and  a 
certain  amount  of  entertainment;  but  the  intervals,  the  so-called 
“recreation  times,”  are  often  left  unfilled.  Here  is  where  books 
are  useful.  The  writer  visited  a state  hospital  not  long  ago,  just 
after  the  dinner  hour.  In  a secluded  corner  of  the  great  dining- 
room which  was  being  rapidly  cleared,  sat  a patient  absorbed  in  a 
book.  On  being  asked  what  she  was  reading  she  looked  up 
brightly  and  said,  “0  I have  such  a splendid  story!  I am  just 
finishing  it  while  I am  waiting  till  the  dishes  are  ready  to  be 
washed.”  This  patient  had  been  on  her  feet  all  the  morning, 
helping  in  the  kitchen,  and  would  soon  be  working  again,  but  in 


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the  meantime  she  was  snatching  her  bit  of  color  and  romance  to 
set  in  the  midst  of  her  gray  and  sombre  life.  In  another  state 
hospital,  in  a sunny  window  in  the  work-room,  one  patient  was 
reading  aloud  to  half-a-dozen  others  who  were  busy  sewing. 
They  had  read  several  books  together  in  this  way.  In  the  farm 
colonies,  where  the  men  and  women  work  all  day  in  the  fields  or 
the  shops,  the  evenings  pass  much  more  pleasantly  and  health- 
fully if  there  are  plenty  of  books  and  magazines  and  papers  to 
look  over  after  supper. 

Years  of  experience  in  one  of  the  large  private  hospitals  has 
proved  the  necessity  of  the  library  in  such  an  institution.  Books 
are  always  kept  on  the  sitting-room  tables  of  the  wards  in  this 
hospital,  changed  every  two  weeks,  so  that  the  patients  are  on 
the  lookout  for  new  books.  There  are  many  instances  of  patients 
who  have  become  interested  in  reading  from  looking  at  these 
books.  New  patients  (unless  too  ill  or  too  destructive)  are  al- 
ways provided  with  stories  or  pictures  to  suit  their  mood.  While 
one  cannot  affirm  that  reading  the  right  sort  of  books  is  in  itself 
a factor  toward  recovery,  certainly  it  is  a great  help  in  the  pro- 
motion of  comfort  and  happiness,  and  in  bringing  the  mind  into 
more  normal  relations  with  the  world,  and  these  are  the  things 
that  make  for  recovery  where  recovery  is  possible.  Here  is  an 
instance  showing  what  the  library  meant  to  one  patient:—  the 
first  coherent  letter  for  weeks  from  one  young  man  was  written 
after  reading  a book  very  carefully  selected  to  suit  his  individual 
needs  and  s,ent  from  the  library;  he  wrote  his  sister  an  analysis  of 
the  plot  and  a good  criticism  of  the  book  as  a whole.  This  book 
was  the  very  first  thing  in  which  that  patient  had  taken  any  in- 
terest whatsoever.  Following  this  clue,  he  was  given  other  books 
of  the  same  sort,  well- written,  thoughtful,  with  enough  adventure 
to  hold  his  attention.  They  were  not  always  easy  to  find,  for  this 
sort  of  book  is  the  ideal  achievement;  but  only  such  would  he  read. 
As  the  process  of  his  recovery  seemed  to  date  from  that  first  story, 
his  family  are  firmly  convinced  that  to  the  library  they  owe  his 
ultimate  recovery.  In  all  probability  something  else  might  have 
aroused  him  in  time,  but  as  a matter  of  fact  it  was  a book. 

Patients  often  tell  us  that  they  owe  more  to  the  library  than  to 
any  other  one  department;  the  reason  for  this  probably  lies  in  the 
fact  that  it  is  uninstitutional  and  homelike  as  it  is  possible  to  make 
it,  and  that  in  these  rooms,  s-urrounded  by  the  familiar  backs  of 


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the  books  they  have  known  and  loved,  they  feel  freer,  less 
restrained,  in  a more  normal  atmosphere.  But  to  achieve  such  an 
effect  requires  constant  attention.  New  books  must  be  bought, 
and  they  must  be  displayed  where  the  patients  will  find  them; 
the  library  must  be  placed  on  open  shelves,  for  your  true  book- 
lover  loves  to  browse.  To  really  get  the  very  best  and  most 
out  of  a hospital  library  requires  all  the  time  and  thought  of 
one  person,  for  here,  fully  as  much  if  not  more  than  in  any 
other  department,  enters  in  the  personal  equation,  the  knowledge 
of  individual  tastes,  the  intuitive  perception. 

The  central  library  seems  to  be  essential.  It  has  been  proved 
over  and  over  again  that  patients  will  not  read  the  books  in  the 
ward  bookcases  unless  they  are  frequently  renewed.  Ward 
bookcases,  filled  with  books  which  have  been  there  for  years 
might  as  well  be  in  the  attic  so  far  as  their  use  is  concerned. 
They  are  more  or  less  decorative,  but  they  will  never  be  looked 
at  unless  a patient  is  perfectly  desperate  for  something  to  read. 

It  is  also  true  that  in  the  central  library,  any  hospital  can 
get  better  results  from  two  hundred  well  chosen,  readable  books,  * 
classified  if  not  catalogued,  than  from  two  thousand,  or  even 
ten  thousand  books  which  no  one  wants  to  read,  placed  on  the 
shelves  helter-skelter  by  shelf-and-book  or  accession  number. 
The  first  step  toward  organization  is  ruthless  elimination  and  the 
furnace  fire.  The  next  is  classification.  The  third  is  to  take  off  the 
paper  covers  so  that  the  library  may*  present  some  individuality. 

If  the  books  get  much  soiled,  they  may  be  shellaced. 

The  question  has  often  been  asked  if  it  is  worth  while  for  a 
state  hospital  to  try  to  have  a library  if  it  cannot  afford  a 
librarian.  Surely  it  is,  if  by  a librarian  is  meant  one  trained  to 
the  business.  Such  a librarian  will,  without  doubt,  get  about 
ten  times  as  much  out  of  the  books  as  an  untrained  one,  will  do 
things  more  easily  and  in  less  time,  and  will  succeed  in  interest- 
ing the  patients  to  a much  greater  degree;  but  failing  a trained 
librarian,  there  are  usually  patients  who  can  do  the  work  and  who 
would  take  great  pride  in  developing  existing  possibilities,  and 
who  might  be  capable,  with  a little  guidance,  of  organizing  a 
really  up-to-date  library  out  of  a mere  collection  of  books.  In 
allowing  the  patients  to  have  a hand  in  this,  the  state  hospital 
achieves  a two-fold  purpose;  these  patients  are  employed  in  doing 
useful,  creative  work  and  other  patients  reap  the  benefits. 


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Beside  the  patients,  there  is  another  class  of  people  in  the  hos- 
pital, to  whom  the  library  may  be  of  great  value, —namely,  the 
nurses.  Many  of  them  have  had  few  advantages,  some  of  them 
have  had  only  a grammar  school  education,  though  perhaps  more 
have  graduated  from  High  Schools,  and  a few  have  been  to  college. 
These  young  men  and  women  come  to  the  hospitals  to  receive  a 
training  which  shall  enable  them  to  earn  a living.  Some  of  them 
are  tremendously  in  earnest  and  eagerly  seize  every  bit  of  help 
which  comes  their  way.  The  hospitals,  general  as  well  as  mental, 
have  long  given  them  training  along  special  lines,  but  now  the  de- 
mand is  for  more  cultured,  better  educated,  more  companionable 
nurses  for  private  patients.  ‘‘We  can  get  all  the  nurses  we  want 
for  physical  ailments,”  is  the  cry  of  the  modern  physicians,  “but 
the  nurse  who  can  go  into  a cultivated  home  and  be  a friend  and 
companion  is  hard  to  find.” 

The  fact  is,  the  college-trained  man  or  woman  does  not  often 
select  nursing  as  a profession.  The  hospital  training-schools  have 
had  to  take  what  material  they  could  get  and  make  the  most  of  it. 
If  the  demand  is  for  better  educated  nurses,  the  training-schools 
must  either  raise  their  standard  for  admission  (which  would  de- 
bar many  of  their  best  nurses,)  or  they  must  give  their  students 
an  opportunity  to  meet  the  new  demand.  With  a good  library 
at  hand  and  someone  willing  and  able  to  guide  them  in  their 
choice  of  books,  they  can  get  a certain  amount  of  education 
and  a degree  of  culture  in  a surprisingly  short  time  merely 
from  reading  systematically,  but  every  one  knows  how  hard 
it  is  to  undertake  a course  of  study  by  one’s  self.  Recognizing 
this,  in  many  hospitals  during  the  last  year  or  two,  literature 
courses  have  been  talked  of,  and  in  at  least  one,  McLean, 
such  a course  has  been  organized  with  very  satisfactory  re- 
sults. Most  of  the  nurses  have  been  eager  for  the  lectures, 
have  read  as  many  as  possible  of  the  books  mentioned,  and 
have  made  good  comments  on  them.  Some  of  them  have 
frankly  said  that  a new  world  of  books  has  been  opened  up 
to  them.  An  experimental  course  in  the  history  of  Fine  Arts 
is  now  being  tried  in  the  same  hospital.  Both  these  courses, 
however,  would  be  impossible  without  an  adequate  library  to 
drawT  on. 

Yet  even  without  these  culture  courses,  those  nurses  who 
are  at  all  inclined  may  make  good  use  of  the  books  at  their 


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disposal.  One  physician  with  a large  city  practice  recently 
told  a former  patient  of  the  hospital  in  which  the  physician 
had  received  training  as  a nurse,  that  he  owed  all  his  success 
to  the  library  of  that  hospital;  that  he  had  gone  there,  a 
poor  boy  from  an  isolated  farm,  with  no  advantages,  but 
hungry  for  knowledge;  in  the  hospital  library  he  found  books 
of  science  which  he  read  with  avidity,  and  thus  was  decided 
his  profession. 

It  is  true  that  hospitals  in  large  cities  or  towns  find  the  public 
libraries  ready  to  supply  them  with  books,  and  many  of  them 
avail  themselves  of  such  privileges.  Nevertheless,  the  public 
libraries  already  have  a wide  field  of  readers,  and  new  books 
are  a long  time  in  getting  round  the  circle.  The  great  thing  in 
a psychiatric  hospital  is  to  have  the  thing  you  want  just 
when  you  want  it;  if  you  have  to  rely  on  a public  library, 
the  need  for  a certain  book  is  often  past  by  the  time  the 
book  is  secured.  Therefore  each  hospital  should  have  its  own 
library,  however  small,  with  at  least  a few  new  books  added 
at  as  frequent  intervals  as  possible,  and  someone,  librarian, 
officer  or  patient,— the  best  available— to  see  that  the  books 
reach  the  patients  and  accomplish  their  purpose  of  recreation 
or  education.  The  public  library  may  be  drawn  on  to  supple- 
ment the  one  in  the  hospital,  but  the  best  results  surely  must 
be  obtained  from  the  books  which  are  at  hand  when  they  are 
wanted. 

A good  library  is  not  so  expensive  after  all.  Each  hundred 
dollars,  judiciously  expended,  will  yield  approximately  one  hun- 
dred books.  An  annual  appropriation  of  one  hundred  dollars  is 
not  a prohibitive  sum,  and  as  there  are  not,  in  these  degener- 
ate days,  one  hundred  novels  worth  reading  produced  in  any 
one  year,  the  departments  of  literature,  travel,  etc.  may  be  in- 
creased materially  by  taking  advantage  of  remainder  sales, 
and  a few  visits  to  second-hand  book  shops  for  inexpensive 
but  good  editions.  So  each  hundred  dollars  expended  in 
books  furnishes  the  means  toward  mental  health  for  many 
successive  years  to  hundreds  of  patients  and  employees.  It  is 
drawing  interest  all  the  time  in  recreation  and  education— in 
the  world  above  the  foundation  line  of  creature  comfort,— the 
world  of  intellectual  and  spiritual  life  in  which  we  really 
live,  and  which  keeps  us  happy. 


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